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F0600
D

Failure to Prevent Resident-to-Resident Physical Abuse

Windsor, North Carolina Survey Completed on 11-14-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

A deficiency occurred when a resident with intact cognition struck another resident with moderately impaired cognition, resulting in a bruise to the right side of the face. The incident took place in the dining room area after one resident attempted to assist the other, who was stuck in a doorway in his wheelchair. The situation escalated when the resident being assisted began to curse and use racially charged language toward the other resident. Despite the Assistant Director of Nursing (ADON) intervening and instructing the resident not to hit, the resident proceeded to slap the other on the face. Documentation and interviews confirmed that the altercation was witnessed by the ADON, who heard yelling and responded to the scene. The resident who was struck did not recall the incident during a subsequent interview, while the resident who struck claimed he did not make contact, though the ADON and documentation confirmed otherwise. The incident resulted in a physical injury (bruise) and was reported to the police, with the resident who struck being charged with assault.

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